Biopsychosocial Influence on Shoulder Pain

 描述(由申请人提供)：针对特定患者特征(即个性化药物)量身定做的治疗将对医疗保健的提供产生重大的积极影响。 针对肌肉骨骼疼痛情况的个性化药物是一个高度优先事项，因为这些情况对社会造成了沉重的负担，因为它们造成了经济影响和痛苦。因此，这一系列研究的最终目标是开发针对肌肉骨骼疼痛的个性化干预措施，以缓解肌肉骨骼疼痛并减轻其对社会的负担。我们研究肩痛是因为它是一种常见的肌肉骨骼疼痛状况，在最初的资助期间，我们确定了指示慢性肩痛的遗传和心理风险因素的组合。特别是，COMT基因变异和疼痛灾变的组合形成了一个高危亚组，在临床前运动诱导损伤队列中预测肩痛反应增强，在临床术后肩痛队列中预测不良的12个月结果。这一充满希望和强有力的发现推动了这一研究向干预阶段的过渡。续签申请将为这个多学科研究团队提供资源，以确定个性化药物和心理疼痛干预的机制和有效性，旨在针对构成高危亚组的遗传和心理因素。药物干预将是心得安，因为它抵消了COMT酶降低的影响。心理干预将是认知重组，以减轻痛苦灾难的影响。我们的主要假设是，与联合安慰剂相比，接受个性化药物和个性化心理干预相结合的受试者在运动性肩部损伤后肩部疼痛持续时间、峰值疼痛强度和峰值上肢残疾程度将会降低。此外，我们还将研究心理、分子和疼痛敏感性调节作为缓解疼痛的机制。这项拟议研究的成功完成将对该领域产生重大影响，因为它有可能改变护理标准，为个人发现有效的个性化疼痛治疗方法，如果没有治疗，这些疼痛将继续发展为慢性肩痛。这项研究的完成还将为在术后肩痛队列中设计后续临床试验提供关键的基础数据。

 DESCRIPTION (provided by applicant): Treatment tailored to specific patient characteristics (i.e. personalized medicine) will have a significant positive impact on the delivery of healthcare. Personalized medicine for musculoskeletal pain conditions is a high priority because these conditions are a heavy burden to society due their economic impact and suffering they cause. Therefore, the ultimate goal of this line of research is to develop personalized interventions for musculoskeletal pain that ameliorate musculoskeletal pain and lessen their burden on society. We study shoulder pain because it is a common musculoskeletal pain condition and in the initial funding period we identified combinations of genetic and psychological risk factors indicative of chronic shoulder pain. In particular, a combination of COMT genetic variants and pain catastrophizing formed a high risk subgroup predictive of heightened shoulder pain responses in a pre-clinical exercise-induced injury cohort and poor 12 month outcomes in a clinical post-operative shoulder pain cohort. This promising and robust finding provided the impetus to transition this line of research to an intervention phase. The renewal application will provide resources for this multidisciplinary research team to determine mechanisms and efficacy of personalized pharmaceutical and psychological pain interventions designed to target genetic and psychological factors that comprise the high risk subgroup. The pharmaceutical intervention will be propranolol as it counters the effects of decreased COMT enzyme. The psychological intervention will be cognitive restructuring that lessen the impact of pain catastrophizing. Our primary hypothesis is that subjects receiving the combined personalized pharmaceutical and personalized psychological intervention will have decreased shoulder pain duration, peak pain intensity, and peak upper-extremity disability following exercise-induced shoulder injury, when compared to the combined placebo condition. In addition, we will investigate psychological, molecular, and pain sensitivity regulation as mechanisms of pain relief. Successful completion of the proposed study will have a strong impact on the field as it has the potential to alter standard of care by discovering effective personalized pain treatments for individuals that, without the treatments, would go on to develop chronic shoulder pain. Completion of this study will also provide critical foundational data for designing a subsequent clinical trial in a post-operative shoulder pain cohort.